Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

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Abstract

Background

There is a need for primary care interventions for patients with multiple medically unexplained symptoms (MUS). We examined whether GPs could be taught to deliver one such intervention, the Symptoms Clinic Intervention (SCI), to patients. The intervention includes recognition and validation of patients' symptoms, explanation of symptoms and actions to manage symptoms.

Methods

We conducted an uncontrolled observational study in North East Scotland. GPs were recruited and received two days of structured training. Patients were identified via a two stage process (database searching followed by postal questionnaire) and received the SCI intervention from a GP in their practise.

Treatment fidelity was assessed by applying a coding framework to consultation transcripts. Safety was assessed by examining changes in patient symptom (PHQ-15) and checking for unexpected events. Acceptability was primarily assessed by patient interview.

Results

Four GPs delivered the SCI to 23 patients. GPs delivered all core components of the SCI, and used the components flexibly across the consultations and between patients. They spent more time on recognition than either explanation or actions components. 10 out of 17 patients interviewed described feeling validated, receiving useful explanation and learning actions. 9 out of 20 patients (45%) reported an improvement in PHQ-15 of between 3 and 8 points. Patients who reported the most improvement also described receiving all three components of the intervention.

Conclusions

GPs can be taught to deliver the SCI with reasonable fidelity, safety and acceptability, although some items were inconsistently delivered: further training would be needed before use.
Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalJournal of Psychosomatic Research
Volume84
Early online date18 Mar 2016
DOIs
Publication statusPublished - May 2016

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General Practitioners
Safety
Therapeutics
Medically Unexplained Symptoms
Referral and Consultation
Scotland
Observational Studies
Primary Health Care
Emotions
Learning
Databases
Interviews

Keywords

  • medically unexplained symptoms
  • observational study
  • intervention
  • primary care

Cite this

@article{3ddf9f6cabc742eebeab2b8cd781da8a,
title = "Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms",
abstract = "BackgroundThere is a need for primary care interventions for patients with multiple medically unexplained symptoms (MUS). We examined whether GPs could be taught to deliver one such intervention, the Symptoms Clinic Intervention (SCI), to patients. The intervention includes recognition and validation of patients' symptoms, explanation of symptoms and actions to manage symptoms.MethodsWe conducted an uncontrolled observational study in North East Scotland. GPs were recruited and received two days of structured training. Patients were identified via a two stage process (database searching followed by postal questionnaire) and received the SCI intervention from a GP in their practise.Treatment fidelity was assessed by applying a coding framework to consultation transcripts. Safety was assessed by examining changes in patient symptom (PHQ-15) and checking for unexpected events. Acceptability was primarily assessed by patient interview.ResultsFour GPs delivered the SCI to 23 patients. GPs delivered all core components of the SCI, and used the components flexibly across the consultations and between patients. They spent more time on recognition than either explanation or actions components. 10 out of 17 patients interviewed described feeling validated, receiving useful explanation and learning actions. 9 out of 20 patients (45{\%}) reported an improvement in PHQ-15 of between 3 and 8 points. Patients who reported the most improvement also described receiving all three components of the intervention.ConclusionsGPs can be taught to deliver the SCI with reasonable fidelity, safety and acceptability, although some items were inconsistently delivered: further training would be needed before use.",
keywords = "medically unexplained symptoms, observational study, intervention, primary care",
author = "Lakrista Morton and Alison Elliott and Ruth Thomas and Jennifer Cleland and Vincent Deary and Christopher Burton",
note = "Acknowledgements This study was funded by the Chief Scientist Office of the Scottish Government, grant CZH_4_495.",
year = "2016",
month = "5",
doi = "10.1016/j.jpsychores.2016.03.008",
language = "English",
volume = "84",
pages = "37--43",
journal = "Journal of Psychosomatic Research",
issn = "0022-3999",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

AU - Morton, Lakrista

AU - Elliott, Alison

AU - Thomas, Ruth

AU - Cleland, Jennifer

AU - Deary, Vincent

AU - Burton, Christopher

N1 - Acknowledgements This study was funded by the Chief Scientist Office of the Scottish Government, grant CZH_4_495.

PY - 2016/5

Y1 - 2016/5

N2 - BackgroundThere is a need for primary care interventions for patients with multiple medically unexplained symptoms (MUS). We examined whether GPs could be taught to deliver one such intervention, the Symptoms Clinic Intervention (SCI), to patients. The intervention includes recognition and validation of patients' symptoms, explanation of symptoms and actions to manage symptoms.MethodsWe conducted an uncontrolled observational study in North East Scotland. GPs were recruited and received two days of structured training. Patients were identified via a two stage process (database searching followed by postal questionnaire) and received the SCI intervention from a GP in their practise.Treatment fidelity was assessed by applying a coding framework to consultation transcripts. Safety was assessed by examining changes in patient symptom (PHQ-15) and checking for unexpected events. Acceptability was primarily assessed by patient interview.ResultsFour GPs delivered the SCI to 23 patients. GPs delivered all core components of the SCI, and used the components flexibly across the consultations and between patients. They spent more time on recognition than either explanation or actions components. 10 out of 17 patients interviewed described feeling validated, receiving useful explanation and learning actions. 9 out of 20 patients (45%) reported an improvement in PHQ-15 of between 3 and 8 points. Patients who reported the most improvement also described receiving all three components of the intervention.ConclusionsGPs can be taught to deliver the SCI with reasonable fidelity, safety and acceptability, although some items were inconsistently delivered: further training would be needed before use.

AB - BackgroundThere is a need for primary care interventions for patients with multiple medically unexplained symptoms (MUS). We examined whether GPs could be taught to deliver one such intervention, the Symptoms Clinic Intervention (SCI), to patients. The intervention includes recognition and validation of patients' symptoms, explanation of symptoms and actions to manage symptoms.MethodsWe conducted an uncontrolled observational study in North East Scotland. GPs were recruited and received two days of structured training. Patients were identified via a two stage process (database searching followed by postal questionnaire) and received the SCI intervention from a GP in their practise.Treatment fidelity was assessed by applying a coding framework to consultation transcripts. Safety was assessed by examining changes in patient symptom (PHQ-15) and checking for unexpected events. Acceptability was primarily assessed by patient interview.ResultsFour GPs delivered the SCI to 23 patients. GPs delivered all core components of the SCI, and used the components flexibly across the consultations and between patients. They spent more time on recognition than either explanation or actions components. 10 out of 17 patients interviewed described feeling validated, receiving useful explanation and learning actions. 9 out of 20 patients (45%) reported an improvement in PHQ-15 of between 3 and 8 points. Patients who reported the most improvement also described receiving all three components of the intervention.ConclusionsGPs can be taught to deliver the SCI with reasonable fidelity, safety and acceptability, although some items were inconsistently delivered: further training would be needed before use.

KW - medically unexplained symptoms

KW - observational study

KW - intervention

KW - primary care

U2 - 10.1016/j.jpsychores.2016.03.008

DO - 10.1016/j.jpsychores.2016.03.008

M3 - Article

VL - 84

SP - 37

EP - 43

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

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